A Phase I Trial of Intraperitoneal Mesothelin-Targeted CAR T-Cell Therapy in Patients With Mesothelin-Positive Esophagogastric Adenocarcinoma With Peritoneal Carcinomatosis
Participants will have a sample of their white blood cells, called T cells, collected using a procedure called leukapheresis. The collected T cells will be sent to a laboratory at Memorial Sloan Kettering to be changed (modified) to become MSLN-targeted CAR T cells, the CAR T-cell therapy that participants will receive during the study. Participant study therapy will take about 3-4 weeks.
• Aged ≥18 years
• Diagnosis of pathologically confirmed EG adenocarcinoma
• Diagnosis of metastatic or recurrent disease
• ECOG performance status of 0-1
• Life expectancy of ≥4 months
• Written informed consent for the study (from participant)
• Life expectancy of ≥4 months
• ECOG performance status of 0-1
• Histologic diagnosis that \& \>25% of the tumor expresses MSLN by IHC analysis. Archival tissue obtained up to 2 years before study enrollment is acceptable. IHC testing of a cell block from cytology (e.g., ascitic fluid) is acceptable if approved by the study pathologist. If adequate archival tissue is not available at screening, a fresh tumor biopsy should be obtained
• Stage IV disease with gross peritoneal carcinomatosis on imaging and/or microscopic peritoneal involvement by cytology or noted during diagnostic laparoscopy
• Disease progression or treatment intolerance after receiving at least 1 treatment regimen in the metastatic setting; patients with disease recurrence within 6 months of completing curative systemic therapy (chemotherapy, chemoradiation or adjuvant immunotherapy) are also eligible
• Patients with Her2 positive disease must have received ≥1 line of anti-Her2 based therapy
• At least 1 measurable or evaluable lesion per RECIST 1.1. Screening imaging must be obtained within 6 weeks of signing the informed consent form
• Completion of systemic therapy at least 7 days before leukapheresis
• o Immune checkpoint inhibitor therapy must be completed at least 14 days before leukapheresis
• Lab requirements (hematology):
‣ Absolute neutrophil count ≥1.0 K/mcL
⁃ Hemoglobin ≥9 gm/dL
⁃ Platelet count ≥75 K/mcL
⁃ Blood product transfusion or growth factor support cannot occur within 7 days of testing
• Lab requirements (serum chemistry):
‣ Bilirubin ≤1.5× upper limit of normal (ULN)
⁃ Serum alanine aminotransferase and serum aspartate aminotransferase (ALT/AST) level ≤3× ULN
⁃ Calculated clearance of ≥50 mL/min by Cockcroft-Gault equation
• Negative screen for infectious disease markers, including hepatitis B core antibody, hepatitis B surface antigen, hepatitis C antibody, HIV 1-2 antibody, HTLV antibody and syphilis antibody
• o Note: Patients with a history of hepatitis B virus infection are eligible if the hepatitis B viral load is undetectable. Patients with a history of hepatitis C virus infection who were treated for hepatitis C and cured are eligible if the hepatitis C viral load is undetectable
• Serum pregnancy test with negative result at screening and preconditioning and must be willing to use effective and reliable contraception for at least 12 months after T cell infusion (for female participants of childbearing age)
• Resolution of all acute toxic effects of any previous therapeutic or palliative chemotherapy, radiotherapy, or surgical procedures to grade ≤1 (CTCAE v5.0), except for neuropathy and alopecia
• Life expectancy of ≥4 months
• ECOG performance status of 0-1
• At least 1 measurable or evaluable lesion per RECIST 1.1. Screening imaging must be obtained within 4 weeks before the date of lymphodepletion
• Completion of systemic therapy at least 14 days before lymphodepleting chemotherapy
• o Immune checkpoint inhibitor therapy must be completed at least 28 days before lymphodepleting chemotherapy
• Lab requirements (hematology):
‣ Absolute neutrophil count ≥1.5 K/mcL
⁃ Hemoglobin ≥8 gm/dL
⁃ Platelet count ≥75 K/mcL
• Lab requirements (serum chemistry):
‣ Bilirubin ≤1.5× upper limit of normal (ULN)
⁃ Serum alanine aminotransferase and serum aspartate aminotransferase (ALT/AST) level ≤3× ULN
⁃ Calculated clearance of ≥50 mL/min by Cockcroft-Gault equation
• Serum pregnancy test with negative result within 7 days of planned lymphodepletion date and must be willing to use effective and reliable contraception for at least 12 months after T cell infusion (for female participants of childbearing age)
• Resolution of all acute toxic effects of any previous therapeutic or palliative chemotherapy, radiotherapy, or surgical procedures to grade ≤1 (CTCAE v5.0), except for neuropathy and alopecia
∙ Participant Exclusion Criteria